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Diabetes Disaster Averted #34: Changing Medication Formulation

I recently had a type 2 patient who was blending his foods due to gastroparesis. He would put his foods in a blender before eating to get better and timelier absorption….

He was taking Glucophage XR (metformin extended release) and Glucotrol XL (glipizide extended release) which are medications formulated to dissolve slowly and therefore be released over a longer period of time. He takes one of each in the morning and one each in the evening. He was having a problem with elevated blood sugars in the afternoons and in the mornings. On many days he would have low blood sugars right after breakfast and dinner.

When I asked him how he took all of his medications (6 meds) he explained to me that he would crush the tablets and add to his blended foods. Since he was taking the extended release forms, I explained to him that they are formulated so they will be released slowly over 8-12 hours, and by crushing them he would cause the medication to be released all at once, which would increase levels directly after consumption, not way they were intended to work.

Lesson Learned:

Not all long acting medications are formulated this way. Some medications are inherently long acting and so crushing does not change the release. It is a good idea whenever patients are using a time-release type of medication, to review the package insert or check ISMP’s “Do Not Crush” list to see if it is okay to alter the delivery system.

Michael Levin, PharmD.

Just follow this link for a copy of the ISMP’s (Institute for Safe Medication Practice) Do Not Crush List.

Editors Note: Oftentimes patients take foods that have little effect on glucose and will choose to juice or blend them. These foods in their natural form may contain high amounts of fiber and are digested very slowly. However, juicing them can break down the fibrous bonds and cause faster absorption and unexpected high glucose readings.

Report Medication Errors to ISMP:

Diabetes in Control is partnered with the Institute for Safe Medication Practices (ISMP) to help ensure errors and near-miss events get reported and shared with millions of health care practitioners. The ISMP is a Patient Safety Organization obligated by law to maintain the anonymity of anyone involved, as well as omitting or changing contextual details for that purpose. Help save lives and protect patients and colleagues by confidentially reporting errors to the ISMP.

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